Healthcare Provider Details

I. General information

NPI: 1114423936
Provider Name (Legal Business Name): LAUREN LEIGH HALEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN LEIGH BOX FNP-BC

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 23RD ST NW
FAYETTE AL
35555-1001
US

IV. Provider business mailing address

110 23RD ST NW
FAYETTE AL
35555-1001
US

V. Phone/Fax

Practice location:
  • Phone: 205-932-3891
  • Fax: 205-487-8827
Mailing address:
  • Phone: 205-932-3891
  • Fax: 205-487-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-140252
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: